Most Consumers Look to Payers for Healthcare Price Transparency

Not many consumers are asking how much healthcare services cost but among those who do, they are seeking answers primarily from their insurance companies, according to a new poll on healthcare price transparency.

The YouGov survey, commissioned by the AI for healthcare company AKASA, polled over 2,000 American adults earlier this year on whether they research prices for healthcare services and if so, how they do so. Just 36 percent of respondents indicated that they research prices for healthcare services. Of those individuals, 60 percent said they would look to their health insurance companies for pricing information, with almost half (44 percent) saying they would look on the insurer websites and over a quarter (29 percent) would call their insurance company.

Health payers are required by CMS to disclose pricing information, including in-network provider rates for all covered services and items and allowed amounts for out-of-network providers. Payers must also allow consumers to get an estimate of their cost-sharing responsibility for a specific service or item from a specific provider for at least 500 items and services.

Payer healthcare price transparency requirements went into effect earlier this month but hospitals have been doing this for well over a year now.

The federal government started its healthcare price transparency initiative by requiring hospitals to post pricing information for all items and services their providers furnish to patients. The information includes gross charges, discounted cash prices, payer-specific negotiated charges, and de-identified minimum and maximum negotiated charges.

Hospitals must also publish a consumer-friendly display of at least 300 shoppable services that a consumer can schedule in advance. This list must be in plain language and include any ancillary services.

Hospitals have criticized the healthcare price transparency requirements, arguing that patients would be more empowered to shop for healthcare services if they knew their out-of-pocket responsibility rather than hospital prices, which consumers very rarely pay. Many stakeholders have urged the government to focus more on payer healthcare price transparency rather than hospital price transparency.

The YouGov survey suggests that hospitals are at least partially correct: consumers seem to be seeking pricing information from their health insurers rather than providers. However, that does not mean healthcare price transparency should not be a priority for providers.

The survey found that a fair amount of consumers are looking to their providers for pricing information, including 39 percent of respondents who said they would visit a physician or hospital website and 34 percent who said they could call their physician or hospital for pricing information.

Another 32 percent of respondents who would research healthcare prices said they would do so through their patient portal. Survey authors noted that respondents could select more than one response when asked how they would acquire pricing information.

Additionally, not all payers are providing the right information to consumers, the survey suggested. About 44 percent of respondents said their insurance companies do not provide pricing information for local providers. Another 34 percent said they didn’t know if that information was available.

“Clearly, both providers and payers have a critical role to play, and the healthcare industry as a whole must work together to holistically improve price transparency, which is a key piece of the puzzle to improving the overall patient financial experience,” Ben Beadle-Ryby, co-founder of AKASA, said in a press release.